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Research priorities regarding the use of bisphosphonates for osteoporosis: a UK priority setting exercise

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Abstract

Purpose

Worldwide, many people who would benefit from osteoporosis drugs are not offered or receiving them, resulting in an osteoporosis care gap. Adherence with bisphosphonates is particularly low. This study aimed to identify stakeholder research priorities relating to bisphosphonate treatment regimens for prevention of osteoporotic fractures.

Methods

A three-step approach based on the James Lind Alliance methodology for identification and prioritisation of research questions was used. Research uncertainties were gathered from a large programme of related research studies about bisphosphonate regimens and from recent published international clinical guidelines. Clinical and public stakeholders refined the list of uncertainties into research questions. The third step prioritised the questions using a modified nominal group technique.

Results

In total, 34 draft uncertainties were finalised into 33 research questions by stakeholders. The top 10 includes questions relating to which people should be offered intravenous bisphosphonates first line (1); optimal duration of treatment (2); the role of bone turnover markers in treatment breaks (3); support patient need for medicine optimisation (4); support primary care practitioner need regarding bisphosphonates (5); comparing zoledronate given in community vs hospital settings (6); ensuring quality standards are met (7); the long-term model of care (8); best bisphosphonate for people aged under 50 (9); and supporting patient decision-making about bisphosphonates (10).

Conclusion

This study reports, for the first time, topics of importance to stakeholders in the research of bisphosphonate osteoporosis treatment regimens. These findings have implications for research into implementation to address the care gap and education of healthcare professionals.

Summary

Using James Lind Alliance methodology, this study reports prioritised topics of importance to stakeholders in the research of bisphosphonate treatment in osteoporosis. The priorities address how to better implement guidelines to address the care gap, understanding patient factors influencing treatment selection and effectiveness, and how to optimise long-term care.

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Acknowledgements

The authors thank and acknowledge the help and support of Caroline Sangan, Beth Jones from the Royal Osteoporosis Society, Rachael Taylor who is study coordinator for the Blast Off study, and Alicia Bratt and Lizzie Cottrell from Keele Impact Accelerator Unit.

Funding

This study is funded by the National Institute for Health and Care Research (NIHR) [HTA NIHR127550]. ZP is funded by the NIHR, Clinician Scientist Award (CS-2018–18-ST2-010)/NIHR Academy. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, or the Department of Health and Social Care.

Author information

Authors and Affiliations

  1. School of Medicine, Keele University, David Weatherall Building, Newcastle-Under-Lyme, ST5 5BG, UK

    Zoe Paskins, Alice Moult & Nadia Corp

  2. Haywood Academic Rheumatology Centre, Haywood Hospital, High Lane, Burslem, Stoke-On-Trent, ST6 7AG, UK

    Zoe Paskins

  3. Faculty of Medicine & Health Sciences, University of Nottingham, City Hospital, Nottingham, NG5 1PB, UK

    Anastasios Bastounis

  4. School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK

    Sarah Davis

  5. Nottingham University Business School, University of Nottingham, Nottingham, NG8 1BB, UK

    Melanie Jay Narayanasamy & Simon Bishop

  6. Royal Osteoporosis Society (ROS), St James House, The Square, Lower Bristol Road, BA2 3BH, UK

    Jill Griffin

  7. Centre for Endocrinology, Diabetes and Metabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK

    Neil Gittoes

  8. Centre for Evidence Based Healthcare, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, NG5 1PB, UK

    Jo Leonardi-Bee

  9. Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, NG5 1PB, UK

    Tessa Langley

  10. Department of Healthcare of Older People, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK

    Opinder Sahota

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  1. Zoe Paskins
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Corresponding author

Correspondence to Zoe Paskins.

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Conflicts of interest

ZP reports paid non-promotional consultancy for UCB. AM, NC,AB, MN, JG, NG, JLB, TL, SB, and OS declare that they have no conflicts of interest. SD reports a grant from Roche Diagnostics to her employing institution to fund research into the cost-effectiveness of using a biomarker to monitor response to treatment with antifracture medication.

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Paskins, Z., Moult, A., Corp, N. et al. Research priorities regarding the use of bisphosphonates for osteoporosis: a UK priority setting exercise. Osteoporos Int 34, 1711–1718 (2023). https://doi.org/10.1007/s00198-023-06806-7

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